<div class="form-group col-lg-12 col-md-12 col-sm-12 col-xs-12" id="form_group_{$form.name}">
    <div class="col-xs-12 label-title" for="{$form.name}">{$form.title|htmlspecialchars}</div>
    <div class="col-sm-12  js-address">
    
        <input type="hidden" class="map-province" name="{$form.name}[province]" value="{$form.value.province|default=''|raw}"/> 
        <input type="hidden" class="map-city" name="{$form.name}[city]" value="{$form.value.city|default=''|raw}"/>   
        <input type="hidden" class="map-district"  name="{$form.name}[district]" value="{$form.value.district|default=''|raw}"/>
        
        <input type="hidden" class="map-province_id" name="{$form.name}[province_id]" value="{$form.value.province_id ?? 0}"/>        
        <input type="hidden" class="map-city_id" name="{$form.name}[city_id]" value="{$form.value.city_id ?? 0}"/>        
        <input type="hidden" class="map-district_id" name="{$form.name}[district_id]" value="{$form.value.district_id ?? 0}"/> 
        <input type="hidden" class="map-lng"  name="{$form.name}[lng]" value="{$form.value.lng ?? ''}"/>
        <input type="hidden" class="map-lat"  name="{$form.name}[lat]" value="{$form.value.lat ?? ''}"/>
    
        <div class="input-group">
          <input type="text" class="form-control map-levels" placeholder="{:lang('请输入行政区划')}" value="{$form.value.province|default=''|raw} {$form.value.city|default=''|raw} {$form.value.district|default=''|raw}" readonly>
          <span class="input-group-addon map-btn btn-info" style="cursor:pointer">{:lang('选择省市区')}</span>
        </div>
       
        <textarea class="form-control map-address" rows="3" name="{$form.name}[address]" 
        placeholder="{$form.placeholder|default=lang('请输入详细地址')}" >{$form.value.address|default=''|raw}</textarea>
       
		{notempty name="form.tips"}
        <div class="help-block">{$form.tips|raw}</div>
        {/notempty}
    </div>
</div>